Surgical stapler with mechanisms for reducing the firing force

ABSTRACT

Surgical staplers for use during open and/or laparoscopic surgical procedures are disclosed. Novel firing device trapping assemblies, pushers, staple lines and firing handles are described. Many of the novel devices reduce the overall firing force experienced by the surgeon.

This application is a divisional of application Ser. No. 08/236,379,filed on May 2, 1994, pending.

TECHNICAL FIELD

The present invention relates generally to surgical stapling instrumentsused in open and/or laparoscopic surgical procedures and moreparticularly to the type of surgical stapling instruments used forsubstantially sequentially applying linear parallel rows of staggeredstaples through compressed tissue.

BACKGROUND

Surgical stapling instruments used for substantially sequentiallyapplying parallel, linear rows of staggered staples through compressedliving tissue are well known in the art, and are commonly used forclosure of tissue or organs prior to transection or resection, and forocclusion of organs in thoracic and abdominal plasty procedures.Surgical staplers of this type may be used during an open surgicalprocedure where an incision is made to provide access to the surgicalsite, or during a laparoscopic surgical procedure where tissue staplingis accomplished through a generally cylindrical access tube.

Surgical staplers which substantially sequentially fire staplestypically comprise a staple housing for enclosing the staples prior totheir formation, a pusher having a cam surface, and staple driverssubstantially adjacent each staple. As used herein, when it is said thata surgical stapler "substantially sequentially" fires the staples in alinear row, it is meant that the stapler completes the application ofsome staples in a row before the application of other staples in therow, as opposed to a stapler which generally simultaneously fires all ofthe staples in a row. In a stapler which "generally simultaneously"fires staples, during at least a portion of the movement of its firingmechanism, all of the staples are in motion relative to the staplehousing. The circular stapler disclosed in U.S. Pat. No. 4,754,909generally simultaneously fires a circular array of staples, and thestapler described in EPO Application No. 514 139 to Solyntjes et al.generally simultaneously fires a plurality of linear, parallel rows ofstaggered staples.

In a stapler which substantially sequentially fires staples in a linearrow, the firing mechanism typically comprises a pusher, staple driversgenerally adjacent staples in a staple housing and an anvil. The pusheris movable relative to the staple housing in a firing direction. On itsleading edge, the pusher has a camming surface situated at an acute,included angle with the firing direction. The staple drivers have camfollower surfaces for engaging the camming surface to move the stapledrivers in a staple formation or staple driving direction which istypically perpendicular to the firing direction. Movement of the stapledrivers in the staple formation direction ejects the staples from thestaple housing and presses the ejected staples against specially shapedsurfaces on the anvil to engage, form and close the staples in tissuebetween the staple housing and anvil.

In an unformed condition, staples used in a sequentially fired staplertypically comprise a backspan and a pair of legs projecting from thebackspan that each include a sharp tissue penetrating surface. Duringformation of an individual staple, the tips first pass through tissueand then engage the specially shaped surface of the anvil. The forcerequired to initially buckle or bend the staple legs when they engagethe anvil is relatively greater than the force required to piercetissue.

When properly formed, the staples assume a substantially "B" shapedconfiguration. Improperly or only partially formed staples may result ina variety of adverse consequences for a patient, such as inadequatehemostasis, excessive bleeding or a weakened staple line which couldresult in dehiscence of the anastomosis or leakage.

In the present context, the phrase, "formation force" pertains to theforce required to apply a staple. The phrase "initial maximum formationforce" refers to the initial maximum force encountered during formationof a staple which corresponds to the initial buckling or bending of thelegs. During the formation of staple loops, a second maximum formationforce is encountered that is also substantially greater than the forcerequired to penetrate the tissue. The second maximum formation force maybe greater than the initial maximum formation force. The second maximumformation force corresponds to the formation of the legs into loopsafter the buckling of the legs, but before the legs engage each other orthe backspan, or before the final formation of the legs into loops.

It is also believed that a third maximum formation force may beencountered during the final formation of the staple. The third maximumformation force is believed to correspond to staple legs engaging eithereach other or the backspan, or to the increasing bending forcesencountered by the buckling of the staple legs on an ever shorteningeffective beam length. The third maximum formation force is alsorelatively greater than the maximum force required to pierce tissue.Graphs of the firing force versus pusher displacement are found in U.S.Pat. Nos. 3,494,533 and 4,767,044, but these graphs do not illustratethe third maximum formation force that was discovered by applicants andmentioned above.

FIG. 42 is a graph of the formation force curve in pounds versus thepusher stroke in inches for a prior art titanium staple which wasslightly overcrimped in simulated thin tissue. The staple was a stapledesigned generally for use in a stapler as shown in EPO Application No.514 139 to Solyntjes et al. Each of the first, second and third maximumformation forces are referenced as #1, #2 and #3.

The prior art is replete with mechanisms designed to reduce the overallformation force experienced by the surgeon in firing all of the rows ofstaples in the stapler. For example, U.S. Pat. No. 3,499,591 illustratesa stapler with pusher devices staggered so that peak forces for staplesare not simultaneously encountered. European Patent Application No.545029 discloses further attempts to reduce the operative effort.

A general analysis of the relationship between the pusher, pusher driverand anvil reveals that by reducing the angle between the camming surfaceof the pusher and the firing direction (or conversely, increasing theangle between the camming surface of the pusher and the staple drivingdirection), the force encountered by the surgeon may be reduced. U.S.Pat. No. 3,079,606 to Bobrov et al. and U.S. Pat. No. 3,315,863 to O'Deaillustrate sequentially fired staplers with pushers having cammingsurfaces at small included angles with the firing direction. Theillustrated angles appear to be less than about twenty (20) degrees.

A distal or nose portion for the staple housing is required to house thedistal portion of the pusher while the proximal portion of the pushercompletes the firing of the distalmost staple in a staple row. When thepusher camming surface forms a shallow angle with the firing direction,the distal or nose portion of the staple housing is relatively lengthy.Such staplers encounter problems when used in a surgical procedure whichrequires the stapler to staple tissue in a remote position which is notreadily accessible to a surgeon, as such staplers require relativelylengthy distal end portions (or "noses") of the staple housing toaccommodate the small angled pusher. Examples of such procedures includedeep pelvic or thoracic cavity procedures where space is a limitingfactor.

The distal end portion of a stapler may limit the access of the staplerto the tissue to be stapled. For example, tissue such as bone oradjacent blood vessels may prevent proper placement of such a stapler ontissue. A stapler with a lengthy distal end portion is also believed tobe difficult to maneuver in cramped or tight spaces at least in part dueto the lengthy distal end portion.

These problems are only exacerbated when the sequentially fired staplercomprises a laparoscopic stapler, as the surgeon's access to the tissueto be stapled is even further restricted due to the access tube. It isparticularly important in laparoscopic surgery to provide a cartridge assmall as possible in order to maximize the maneuvering room between thedistal end of the access tube and the tissue to be stapled.

U.S. Pat. No. 4,596,351 to Fedotov et al. discloses a stapler having apusher with a curvilinear camming surface. The angle between thecurvilinear camming surface of the pusher of Fedotov et al. and thefiring direction constantly changes rendering it difficult to accuratelypredict the effective angle encountered during the various stages ofstaple formation.

It is also noted that the pushers of the GIA-60 surgical stapler(generally available from U.S. Surgical Corporation) appear to comprisefirst and second linear camming surfaces, but do not include a thirdlinear camming surface. This stapler is generally designed for use inlaparoscopic surgery.

Other approaches to the problem of reducing the firing force encounteredby a surgeon comprise surgical staplers that are manually fired butinclude a) a mechanism for providing a mechanical advantage, or b) apowered instrument which utilizes stored energy (such as gas stored in acylinder). Staplers with mechanical advantage comprise the 3 cmEndostapler known as the Endo GIA-30, available from U.S. SurgicalCorporation of Norwalk, Conn. and the 6 cm Endostapler known as theEndopath Linear Cutter 60 available from Ethicon, Inc. of Somerville,N.J. However, these types of staplers are expensive to manufacture,complex and do not provide a surgeon with direct feedback as to how theposition of the firing lever travel relates to the length of tissue thathas been stapled (and optionally cut).

Another approach to the problem of reducing the firing force experiencedby a surgeon is shown in U.S. Pat. Nos. 5,083,695 and 5,141,144 theentire contents of which are herein expressly incorporated by reference.FIG. 18 illustrates a problem overcome by these types of staplers. Thestapler 5 illustrated in FIG. 18 comprises a stapler substantially asshown in U.S. Pat. No. 4,863,088. With that stapler 5, the surgeon mustpush with enough force to overcome not only the firing force of thestaples and frictional drag of the pushers and drivers, but also thefrictional side or binding load created by pressing on the knob 6 at alocation spaced from the axis 4 of the firing rod 11. The binding loadis shown in FIG. 18 as the moment M_(F) and is described by thefollowing equation:

    M.sub.F =F.sub.F H

where:

F_(F) =firing force (pounds); and

H=off center height (the distance between the point where the forceF_(F) is applied on the knob 6 and the axis 4 in FIG. 18).

Notably, since the knob 6 is mounted on the side of the stapler 5, whena surgeon presses on the knob 6 in a convenient manner, a moment iscreated about the firing rod 11. If the moment is large enough, it mayeven cause the pushers to engage the staple housing increasing thefriction encountered by the firing assembly of the device. Thus, it canbe seen that the moment may increase the firing force encountered by asurgeon.

The staplers shown in U.S. Pat. Nos. 5,083,695 and 5,141,144 have afiring handle body capable of being fired by simultaneously pressing onboth sides of a firing button. The firing button may be located on bothsides of the stapler to assist in eliminating any appreciable momentM_(F). However, in order to fire the stapler in this manner, surgeonswill use both hands. The surgeon should also push equally on both sidesof the firing button to avoid a resultant moment on the firing rod. Sucha technique is inconvenient during a laparoscopic surgical procedurewhere typically only one of the surgeon's hands is available for firingthe stapler.

Another firing force issue arises when the surgical stapler is designedto apply six parallel rows of staples as opposed to the typical staplerwhich applies only four rows of staples. For example, in laparoscopicsurgery where hemostasis and air leakage of lung tissue are particularlyimportant, it may be desirable to add the fifth and sixth rows ofstaples.

FIG. 16 schematically illustrates a prior art, six row staple patternapplied by the laparoscopic GIA stapler available from U.S. Surgical ofNorwalk, Conn. However, if substantially parallel pushers are used toapply that arrangement of staples, first 2, then 4, then 2, then 4staples are applied. This may lead to a "chatter" problem or a "bumpy"feel to the instrument as peak firing forces fluctuate considerably.Assuming the pushers of the stapler are not staggered, it also requiresthe surgeon to exert a formation force sufficient to simultaneously formfour staples.

DISCLOSURE OF THE INVENTION

The present invention provides a surgical stapler instrument forapplying linear parallel rows of staples through compressed livingtissue. The surgical stapler comprises a handle portion having surfacesadapted to be manually grasped by a surgeon; a cartridge retentionportion and an anvil retention portion. An approximation means mountsthe cartridge and anvil retention portions for relative movement betweena closed position in which the anvil and cartridge retention portionsare in closely spaced relationship for clamping tissue to be stapledtherebetween and an open position in which the anvil and cartridgeretention portions are spaced farther from each other than in the closedposition. The anvil retention portion includes an anvil with a pluralityof specially shaped surfaces.

The cartridge retention portion has a staple housing for enclosing aplurality of staples in substantially parallel, linear rows. Each of thestaples have a backspan and a pair of legs projecting from the backspan.The legs buckle during formation of the staples into their desired "B"shape. The staple housing has staple drivers adjacent staples. Thecartridge retention portion includes a plurality of pushers each havingat least three linear camming surfaces. The pushers may comprise aportion of the staple housing or alternatively the stapler itself.

The staple housing has a plurality of longitudinally extending pusherslots for receiving the pushers to afford movement of the pushers in afiring direction between pre-fired and fired positions, and a pluralityof driver channels for receiving the staple drivers to afford movementof the staple drivers in a staple driving direction between pre-ejectand ejected positions.

Each of the staple drivers has a cam follower surface for engaging thelinear camming surfaces of a pusher to move the staple driver from thepre-eject toward the ejected position to substantially sequentiallyeject the staples from the staple housing and press the ejected staplesagainst the specially shaped surfaces of the anvil to engage, form andclose staples in tissue clamped between the staple housing and theanvil.

According to one aspect of the present invention, the three linearcamming surfaces of the pushers comprise a) a first camming surface forengaging a staple driver during initial tissue penetration of a staple;b) a second camming surface for engaging a staple driver during initialbuckling of the legs of a staple; and c) a third camming surface forengaging a staple driver after the legs of a staple have been initiallybuckled and during the closing of the staple in tissue. The firstcamming surface forms a first included angle with the staple drivingdirection. The second camming surface forms a second included angle withthe staple driving direction that is greater than the first includedangle. The third camming surface forms a third included angle with thestaple driving direction that is different than the first and secondincluded angles.

According to another aspect of the present invention, the proximalportion of a stapler comprises first and second sides, top and bottomportions, a firing handle channel extending between the sides to definea space between the top and bottom portions, and finger engagementsurfaces that are sized and shaped to be engaged by the fingers of astapler firing hand of a surgeon. The stapler further includes a firinghandle mounted in the firing handle channel for movement in the firingdirection between pre-fired and fired positions. The firing handle hasdigit engagement surfaces dimensioned and shaped to be receive a digitsuch as the thumb of the firing hand of a surgeon.

The firing handle channel is sized and shaped to afford passage of atleast one digit of the surgeon's hand from one of the first and secondsides, through the space, to the other of the first and second sides toafford manual grasping of the firing handle. This feature of the staplerprovides an ambidextrous quality in that the stapler is convenientlyfired by both left and right handed surgeons.

The stapler includes a firing rod between the firing handle and thepushers. The firing rod has proximal and distal portions fortransmitting a firing force from the firing handle to the pushers tomove the pushers in the firing direction. The proximal portion of thefiring rod defines a proximal portion firing axis substantially parallelto the firing direction.

The firing handle and proximal portion of the firing rod are constructedand arranged to afford transmission of a force directly along theproximal portion firing axis so that the proximal portion of the firingrod may remain substantially free of a moment caused by the surgeonpressing on the firing handle to move the firing handle from thepre-fired toward the fired position.

The features of the staplers described above may be utilized in anystapler which fires a plurality of parallel rows (2, 3, 4, 5 etc.) ofstaples in compressed tissue. According to another aspect of the presentinvention, the stapler comprises the cartridge retention portion havinga staple housing for enclosing six rows of staples in substantiallyparallel, linear rows. The six rows are spaced laterally across thestaple housing such that any line drawn laterally across the staple linecrosses at least three staples.

In another embodiment of a six row surgical stapler, the staplercomprises the cartridge retention portion having a staple housing forenclosing six adjacent rows of staples in substantially parallel, linearrows. The distance between adjacent staples in the same row defines astaple pitch. In this embodiment the six rows are spaced such that eachrow is longitudinally offset from all of the other rows. Preferably, thestaples in each of the rows are longitudinally offset at least 1/6 ofthe pitch P from any staple in any of the other rows. More preferably,one of the rows is longitudinally offset 1/3 of the pitch from each ofthe adjacent rows.

In another aspect of a surgical stapler for firing six parallel rows ofstaples in compressed tissue, the stapler comprises six rows of staplesthat are separated into a first set of three parallel linear rows and asecond set of three parallel linear rows by a centerline or knife travelline. Each of the three parallel linear rows of staples in the first setare spaced such that it is longitudinally offset from the other two rowsof staples in the first set. Similarly, each of the three parallellinear rows of staples in the second set are spaced such that it islongitudinally offset from the other two rows of staples in the secondset. Preferably, in this embodiment, at least one of the rows of staplesin the first set is longitudinally aligned traps the pushers in thedistal end portion of the staple housing.

As mentioned above, the trapping means comprises at least one of thepushers having a hook surface, the staple housing including a trapsurface in substantially the distal end portion of the staple housingfor receiving the hook surface of the pusher when the pusher is in thefired position, and biasing means for biasing the pusher vertically awayfrom the tissue to be stapled so that the hook surface of the pusher isbiased toward the trap surface of the housing.

Optionally, the stapler may include means mounting the knife forvertical movement between an extended position with the knife projectingvertically beyond the tissue engagement surface of the staple housingand a retracted position with the knife spaced farther from the anvilthan in the extended position. In this embodiment, the knife includes abearing surface, the staple housing has a guide channel having a cuttingmotion portion for receiving the bearing surface of the knife as theknife moves between the pre-fired and fired positions, and the guidechannel has an abutment portion situated approximately perpendicular tothe cutting motion portion of the guide channel for abuting the bearingsurface of the knife to restrict longitudinal movement of the knife fromthe fired toward the pre-fired position. Biasing means are present forvertically biasing the knife from the extended toward the retractedposition.

In another preferred embodiment, the stapler includes a one-way couplingbetween the firing rod, pushers and knife which affords reciprocalmovement of portions of the firing rod between pre-fired and firedpositions but which only affords movement of the pushers and knife fromthe pre-fired toward the fired position. This embodiment provides atactile indication to a surgeon that the stapler has been fired as theresistance to movement of the firing assembly is different for fired andunfired staple housings.

The features of the present invention may be with one of the rows ofstaples in the second set. More preferably, the first set of rows is amirror image of the second set of rows.

Yet another aspect of the present invention comprises a surgical staplerhaving a firing means movable in a firing direction between pre-firedand fired positions to substantially sequentially eject the staples in arow from the staple housing and press the ejected staples against thespecially shaped surfaces of the anvil to engage, form and close staplesin tissue clamped between the staple housing and the anvil. The staplerincludes a firing handle and a firing rod operatively associated withthe firing means for movement between the pre-fired and fired positions,and an optional knife for cutting tissue. The stapler has a means thatis operatively associated with the firing means and mounts the knife formovement between a pre-fired position in which the knife is located inthe proximal portion of the staple housing and a fired position in whichthe knife is located in the distal portion of the staple housing. Thestapler includes a novel trapping means for trapping the knife in thedistal end portion of the staple housing in the fired position and forrestricting return movement of the knife from the fired toward thepre-fired position once the firing means has been moved from thepre-fired to the fired position. Preferably, the trapping means includesan interference member for physically blocking return movement of thepushers from the fired to the pre-fired position.

Preferably, the firing means comprises: a) staple drivers adjacentstaples, and a plurality of pushers each having a camming surface, b)the staple housing having a plurality of longitudinally extending pusherslots adapted to receive the pushers to afford movement of the pushersin the firing direction, and c) a plurality of driver channels forreceiving the staple drivers to afford movement of the staple drivers ina staple driving direction between pre-eject and ejected. positions. Inthis embodiment, the trapping means utilized in surgical staplers usedin either open or laparoscopic surgical procedures. Some of the aspectsof the present invention are particularly useful in staplers utilized inlaparoscopic surgical procedures.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be further described with reference to theaccompanying drawing wherein like reference numerals refer to like partsin the several views, and wherein:

FIG. 1 is a side view of a first embodiment of surgical staplinginstrument according the present invention showing the cartridge andanvil of the stapler in an open position, with middle portions of thestapler omitted to emphasize details of proximal and distal portions ofthe stapler, and with the distal portion of the stapler enlargedrelative to the proximal portion to illustrate details of the distalportion;

FIG. 2 is a side view of the surgical stapling instrument of FIG. 1showing the cartridge and anvil of the stapler in a partially closedposition, and with the distal portion of the stapler enlarged relativeto the proximal portion to emphasize details of the distal portion;

FIG. 3 is a side view of the surgical stapling instrument of FIG. 1showing the cartridge and anvil of the stapler in a closed position, andwith the distal portion of the stapler enlarged relative to the proximalportion to emphasize details of the distal portion;

FIG. 3A is a side view of the surgical stapling instrument of FIGS. 1through 3 which illustrates the proximal and distal ends at the samesize;

FIG. 4 is an enlarged detailed view of the stapler of FIG. 2 takengenerally at the circled portion of FIG. 2;

FIG. 5 is a sectional view of the stapler of FIG. 4 taken approximatelyalong lines 5--5 of FIG. 4;

FIG. 5A is an enlarged perspective view of portions of the stapler ofFIG. 1 which illustrates a clevis;

FIG. 6 is a side view of a second embodiment of surgical staplinginstrument according the present invention showing cartridge and anvilportions of the stapler in an open position and with middle portions ofthe stapler omitted to emphasize details of proximal and distal portionsof the stapler, and with the distal portion of the stapler enlargedrelative to the proximal portion in order to emphasize details;

FIG. 7 is a side view of the stapler of FIG. 6 with the cartridge andanvil of the stapler in a closed position;

FIG. 8 is a sectional view of the stapler of FIG. 7 taken approximatelyalong lines 8--8 of FIG. 7;

FIG. 9 is a sectional view of the stapler of FIG. 7 taken approximatelyalong lines 9--9 of FIG. 7;

FIG. 10 is an enlarged side view of a distal portion of the stapler ofFIG. 6;

FIG. 11 is an enlarged side view of a distal portion of the stapler ofFIG. 7;

FIG. 12 is an enlarged side view of the second embodiment of surgicalstapler according to the present invention with the cartridge and anvilin an emergency open position;

FIGS. 13 through 15 sequentially illustrate the operation of a firingmechanism of a stapler according to the present invention wherein:

FIG. 13 is a side view of a firing mechanism of a stapler according tothe present invention illustrating the positions of a pusher, stapledriver and staple as the staple initially pierces tissue;

FIG. 14 is a side view of a firing mechanism of a stapler according tothe present invention illustrating the positions of a pusher, stapledriver and staple as the legs of the staple begin to buckle;

FIG. 15 is a side view of a firing mechanism of a stapler according tothe present invention illustrating the positions of a pusher, stapledriver and staple as the loops of the staple are forming;

FIG. 16 is a schematic view of portions of six parallel rows of staplesin a pattern created by a prior art stapler or optionally a stapleraccording to the present invention;

FIG. 17 is a schematic view of portions of six parallel rows of staplesin a pattern created by a stapler according to the present invention;

FIG. 18 is a perspective view of a prior art surgical stapler whichillustrates a moment created about the firing rod;

FIG. 19 is a side view of a surgical stapler according to the presentinvention which illustrates the position of a firing handle in apre-fired position in hidden lines and in a fired position in solidlines;

FIG. 20 is a top view of the surgical stapler of FIG. 19;

FIG. 21 is a top view of another embodiment of stapler according to thepresent invention;

FIGS. 22 through 27 are side views of the stapler of FIG. 21 andsequentially illustrate the positions of a pusher and knife during thefiring of the stapler wherein:

FIG. 22 illustrates the pusher and knife in a pre-fired position;

FIG. 23 illustrates the pusher slightly advanced during an initialportion of the firing stroke and the knife in the same longitudinalposition as shown in FIG. 22;

FIG. 24 illustrates the pusher and knife after they have been advanced asignificant portion of the firing stroke;

FIG. 25 illustrates the knife and pusher as they have been advancedslightly more distally than in FIG. 24 with the knife beginning todescend vertically toward the pusher along an abutment surface;

FIG. 26 illustrates the pusher advanced slightly beyond its position inFIG. 25 and the knife descended toward the bottom of the abutmentsurface;

FIG. 27 illustrates the pusher and knife after they have been advancedto a distalmost position and after a lockout device has been actuated;

FIGS. 28 through 35 are side views of another embodiment of a stapleraccording to the present invention and sequentially illustrate thepositions of a pusher and knife during the firing of the staplerwherein:

FIG. 28 illustrates the pusher and knife in a pre-fired position;

FIG. 29 illustrates the pusher slightly advanced during an initialportion of the firing stroke and the knife after it has verticallyascended a ramp surface on the staple housing;

FIG. 30 illustrates the pusher and knife after they have been advanced asignificant portion of the firing stroke;

FIG. 31 illustrates the knife and pusher as they have been advancedslightly more distally than in FIG. 30 with the knife beginning todescend vertically toward the pusher along an abutment surface;

FIG. 32 illustrates the pusher advanced slightly beyond its position inFIG. 31 and the knife descended toward the bottom of the abutmentsurface;

FIG. 33 illustrates the pusher and knife after they have been advancedto a distalmost position and after a lockout device has been actuated;

FIG. 34 is a schematic illustration of portions of a second embodimentof staple rows according to the present invention which simulates a topview with the staples rotated about ninety degrees about their backspansand with the spacing between the rows exaggerated to illustrate details;

FIG. 35 is a schematic view of portions of a third embodiment of staplerows according to the present invention which illustrates six parallelrows of staples in a pattern;

FIG. 36 is a schematic view of portions of a fourth embodiment of staplerows according to the present invention which illustrates six parallelrows of staples in a pattern;

FIG. 37 is a schematic side view of an optional firing rod and knifeassembly according to the present invention;

FIG. 38 is a schematic illustration of the assembly of FIG. 37 takenapproximately at detail 38--38 of FIG. 37 which illustrates thedirection of movement of the assembly during firing and retractionstrokes with arrows;

FIG. 39 is a schematic view of a surgical stapler for use in an opensurgical procedure that may include several aspects of the presentinvention, which illustrates the cartridge and anvil of the stapler in aclosed position;

FIG. 40 is a schematic view of the stapler of FIG. 39 which illustratesthe cartridge and anvil of the stapler in a closed position;

FIG. 41 is a side view of the surgical stapling instrument of FIGS. 6and 7 which illustrates the proximal and distal ends of the stapler atthe same size;

FIG. 42 is a firing force curve for an individual staple throughsimulated thin tissue, which illustrates first, second and third maximumformation force peaks;

FIG. 43 is a side view of a first embodiment of an optional, unformedstaple for use in the stapler according to the present invention;

FIG. 43A is a first example of a cross-section taken about the crosssection lines of FIG. 43;

FIG. 43B is a second example of a cross-section taken about the crosssection lines of FIG. 43;

FIG. 43C is a third example of a cross-section taken about the crosssection lines of FIG. 43;

FIG. 44 is a side view of the staple of FIG. 43 in a formed condition;

FIG. 45 is a side view of a second embodiment of an optional, unformedstaple for use in the stapler according to the present invention;

FIG. 46 is a side view of the staple of FIG. 45 in a formed condition;

FIG. 47 is a side view of a third embodiment of optional formed staplefor use in the stapler according to the present invention;

FIG. 48 is a top view of the staple of FIG. 47;

FIG. 49 is a plan view of a dimple of an anvil for forming the staple ofFIG. 48;

FIG. 50 is a side view of a fourth embodiment of an optional, unformedstaple for use in the stapler according to the present invention;

FIG. 51 is a side view of the staple of FIG. 50 with the staple in aformed condition; and

FIG. 52 is a sectional view of the staple of FIG. 51 taken approximatelyalong lines 52--52 of FIG. 51.

DETAILED DESCRIPTION

Referring now to FIGS. 1 through 5 of the drawing, there is shown afirst embodiment of surgical stapling instrument according to thepresent invention, generally designated by reference numeral 10. Thesurgical stapler 10 is designed to apply staples to compressed tissue,preferably during a laparoscopic surgical procedure.

The stapler 10 may comprise a single use disposable stapler, a reusablesurgical stapler or a reloadable disposable surgical stapler. As used inthis application, the phrase "reusable surgical stapler" means asurgical stapler which may not only be fired several times on the samepatient (with, for example, the use of replaceable cartridges or staplehousings), but may also be sterilized and reused on a different patient.Such a stapler stands in opposition to what is known in the art as a"disposable surgical stapler". While a reloadable disposable surgicalstapler may be reused several times on the same patient, a disposablesurgical stapler is not meant to be sterilized or used on a plurality ofpatients. A single use disposable stapler is designed to be used (fired)once and disposed after that single use.

In general, the stapler 10 comprises a proximal portion including ahandle portion having surfaces 12 adapted to be manually grasped by asurgeon, and a distal portion including a cartridge retention portion 14and an anvil retention portion 16.

The anvil retention portion 16 comprises an anvil having speciallyshaped surfaces 7 (best seen in FIGS. 13-15) the function of which willbe described in greater detail below. The anvil may comprise a permanentanvil or a replaceable anvil. As Used in this application, the phrase"replaceable anvil" means an anvil which may be removed from the staplerby medical personnel, and then replaced with a different, sterilized orrefurbished anvil. A permanent anvil is fixedly attached to an anvilretention portion of the stapler and is not designed to be replacedduring the life of the stapler. An anvil is described in publishedCanadian Patent application No. 1,284,551 and Australian patent documentNo. 589,001 (the contents of each of which are herein incorporated byreference). The anvil may be constructed from, for example, a medicalgrade stainless steel.

Between the proximal and distal portions, the stapler 10 has a housing17 having exterior surface 18 terminating in distal end 19. The exteriorsurface 18 is preferably substantially cylindrical and is sized andshaped to engage the interior surfaces of an access tube of a trocarassembly. The housing 17 is elongate and defines a longitudinal axis L(see FIG. 3A) for the stapler 10.

Preferably, the housing 17 is rotatable about the longitudinal axis L ofthe stapler 10 relative to the proximal portion of the stapler. A collar59 and bearing sleeve 57 allow the housing 17 to rotate relative to theproximal portion of the stapler 10. The collar 59 may have exteriorsurfaces such as ribs for enhancing the manual grasping of the collar bya surgeon.

When the stapler 10 is used during a laparoscopic surgical procedure,the distal portion of the stapler 10 is threaded through the interiorsurfaces of the access tube of a trocar (such as the trocar in U.S. Pat.No. 5,152,754, the entire contents incorporated by reference).Preferably, the access tube engagement surface 18 is dimensioned (sizedand shaped) to engage or abut the interior surfaces of the access tube(not shown) of a trocar to restrict leakage of fluid from the abdominalcavity of a patient. Preferably the access tube engagement surface 18 iscylindrical with an outer diameter slightly less than the inner diameterof the access tube.

The stapler 10 has an approximation means for mounting the cartridge andanvil retention portions 14 and 16 for relative movement between: (1) aclosed position (FIG. 3) in which the cartridge and anvil retentionportions are in closely spaced relationship for clamping tissue to bestapled therebetween and (2) an open position (FIG. 1) in which thecartridge and anvil retention portions 14 and 16 are spaced farther fromeach other than in the closed position. In the open position, tissue tobe stapled may be received between the cartridge and anvil retentionportions 14 and 16.

Generally, the approximation means comprises three assemblies which arebest seen in FIGS. 4 and 5. The first assembly comprises a cartridgeframe 22. The cartridge frame 22 preferably has a U-shaped channeladapted to closely receive exterior surfaces of a staple housing 112 sothat the stapler 10 may comprise a reusable or reloadable disposablestapler.

As discussed above, the housing 17 is rotatable about the longitudinalaxis of the stapler 10 relative to the proximal portion of the stapler10. However, the cartridge frame 22 is mounted on the stapler so thatthe cartridge frame 22 does not move longitudinally or rotate relativeto the housing 17. The cartridge frame 22 has opposite first and secondside bearing surfaces 23 and 25 which are laterally spaced about thelongitudinal axis of the stapler 10 (see FIG. 5A).

The second assembly of the approximation means comprises alongitudinally movable assembly. The longitudinally movable assembly isoperatively associated with a locking lever 28 that is movable betweenan open (FIG. 1) and a closed position (FIG. 3). Pin 29 mounts thelocking lever 28 for pivotal movement relative to the housing 17 aboutthe pin 29. Optionally, the distal portion of the locking lever 28 maybe designed to slightly interfere with the collar 59 when the lockinglever 28 is in the closed position so that, when the locking lever 28 isin the closed position, the interference resists rotation of the housing17 relative to the proximal portion.

Torsion spring 31 biases the locking lever 28 toward the open position.Latch 33 engages retention surfaces on release lever 35 to secure thelocking lever 28 in the closed position against the bias of spring 31.To open the stapler 10, a surgeon moves the release lever 35 laterallyrelative to the locking lever 28 to release the latch 33.

Linkage 37 and pins 38 translate the pivotal movement of the lockinglever 28 into longitudinal, axial movement of collar 39 (Compare FIGS. 1and 3). Bearing ring 41 connects the collar 39 to a control shaft 42 sothat the collar 39 does not move longitudinally relative to the controlshaft 42. The control shaft 42 and collar 39 are axially reciprocablewithin and relative to the housing 17. However, bearing ring 41 doesafford rotational movement of the collar 39 relative to the controlshaft 42 when the proximal portion of the stapler is rotated relative tothe housing 17.

As best seen in FIG. 5A, U-shaped clevis 44 fixedly attaches a pair oftransversely spaced guide members 46 (FIGS. 4 and 5) to the controlshaft 42 so that the guide members 46 do not move relative to thecontrol shaft 42. The first and second bearing surfaces 23 and 25 of thecartridge frame 22 receive and abut their respective guide members 46and assist in constraining the guide members 46 to substantially axiallongitudinal movement relative to the cartridge frame 22.

The guide members 46 each have a first, proximal control groove 51 and asecond, distal control groove 53, the operation of which will bedescribed in greater detail below. To close the stapler 10, the controlshaft 42 is moved proximally from the position in FIG. 1 to the positionin FIG. 3 substantially linearly and parallel to the axis of the stapler10. Reversing the direction of the control shaft 42 (e.g. distalmovement of the shaft 42) opens the stapler 10.

The third assembly of the approximation means of the stapler 10comprises an anvil assembly which includes the anvil retention portion16. The anvil assembly includes a proximal portion 55 sandwiched betweenthe guide members 46 and terminating in proximal end 56. The anvil alsohas distal end 58. Proximal post 62 and fulcrum post or axle 64 arefixedly attached to and project laterally or transversely (relative tothe longitudinal axis of the stapler 10) from spaced positions on theproximal portion 55 of the anvil assembly.

The fulcrum post or axle 64 is sized and shaped to be received in thedistal control grooves 53 of the guide members 46. The fulcrum post 64affords substantially seesaw motion of the anvil assembly relative tothe distal control grooves 53 of the guide members 46.

As best seen in FIGS. 4 and 5, the proximal post 62 projects through theproximal control grooves 51 of the guide members 46 and is sized andshaped to be received in limiter slots 66 of the cartridge frame 22.Unlike the fulcrum post 64 which only projects sufficiently laterally tobe received in the control grooves 53, the proximal post 62 projectslaterally into opposite anvil limiter slots 66 in the cartridge frame22.

The limiter slots 66 are generally perpendicular to the longitudinalaxis of the stapler 10 which limits the longitudinal movement of theanvil relative to the housing 17 (and cartridge frame 22). The limiterslots 66 do, however, afford movement of the proximal post 62 in adirection generally perpendicular to the longitudinal axis (verticallyin FIGS. 1-5) so that the anvil may substantially seesaw about fulcrumpost 64 relative to second control groove 53.

The shapes of the first and second control grooves 51 and 53 areimportant to control the motion of the anvil retention portion 16 as itmoves from an open position (FIG. 1) to a partially closed position(FIG. 2) and finally to a closed position (FIG. 3). FIGS. 1 through 3show preferred embodiments of those shapes. For purposes of thisdiscussion of the preferred embodiment, the anvil may be divided into aleading portion 71 and a trailing portion 73, and the positions of thelocking lever 28 may be described as sequentially proceeding from anopen position (FIG. 1) to a partially closed position (FIG. 2) and thento a closed position (FIG. 3).

During the movement of the locking lever 28 from the open to thepartially closed position, the proximal post 62 is moved by leading edgeclosure portion 82 of first control groove 51 from a vertically lowerposition (FIG. 1) toward a vertically higher position (FIG. 2) in thelimiter slot 66. The leading edge closure portion 82 causes the anvil tosubstantially seesaw about the fulcrum post 64 as the fulcrum post 64 ismoved by an initial surface 83 of second control groove 53. Thesubstantial seesaw movement of the anvil allows the leading portion 71of the anvil to move toward the closed position more rapidly than thetrailing portion 73.

Referring now to FIGS. 2 and 3, during movement of the locking lever 28from the partially closed position to the closed position, the proximalpost 62 is moved by trailing edge closure portion 86 of first controlgroove 51 from the vertical higher position (FIG. 2) to a vertical lowerposition (FIG. 3) in the limiter slot 66. At approximately the sametime, the fulcrum post 64 is moved by a final motion surface 88 ofsecond control groove 53. During the movement of the locking lever 28from the partial closed position to the closed position, the trailingportion 73 of the anvil closes more rapidly than the proximal portion71. In the preferred embodiment shown, the anvil substantially pivotsabout anvil stop 89 during the movement of the lever lock 28 from thepartial closed position to the closed position. This motion resistsextrusion of tissue from between the cartridge retention and anvilportions 14 and 16 and out the distal end of the stapler 10 tobeneficially ensure that tissue remains clamped between the cartridgeretention and anvil portions 14 and 16.

The first and second control slots 51 and 53 also include openingsurfaces 92 for positively moving the anvil from the closed toward theopen position. These surfaces allow a surgeon to positively exert forceon the anvil to move it toward the open position by moving the lockinglever 28 from the closed to the open position, as opposed, for exampleto a system that relies solely on the bias of a spring to open thestapler. This feature also avoids binding of the anvil and cartridgeportions in the closed position when the stapler 10 is used to staplethick or resilient tissue. Optionally, this feature allows the surgeonto use the stapler as an active tissue dissector.

The movement of anvil from the open position (FIG. 1) toward the closedposition (FIG. 3) is referred to as "tip to tail" closure as initiallythe leading portion 71 of the anvil moves toward the closed positionmore rapidly than the trailing portion 73, and then the relative speedsof closure of the leading and trailing portions 71 and 73 are reversed.Preferably, the leading portion 71 reaches a fully closed position priorto the trailing portion 73. This motion is believed to provide desirableclinical results as the initial closure of the distal portion resistsextrusion of tissue from between the cartridge retention and anvilportions of the stapler.

The stapler 10 also includes means for holding and firing a plurality ofstaples. The firing means comprises means for sequentially firing aplurality of staples in a plurality of linear rows. Optionally, thestapler 10 may include a blade or knife 110 for cutting tissue betweenapplied rows of staples. Once the approximation means is closed, thefiring means is used to eject, form and close the staples in tissue. Anexample of a firing means for the stapler 10 may be seen in FIGS. 1-5,13-15 and 21-27.

The cartridge retention portion 14 of the stapler 10 has a staplehousing 112 for enclosing a plurality of staples 114 in substantiallyparallel, linear rows (FIGS. 16, 17 and 34). Typically, the staplehousing 112 is removable from the cartridge retention portion 14 andreplaceable with a replacement staple housing 112 rendering the stapler10 a reusable or reloadable disposable stapler. The staple housing 112may be replaced with a different staple housing so that the stapler 10may be refired. This may be accomplished by including a detent anddetent groove assembly (not shown) on the staple housing 112 and thecartridge frame 22, and optionally bifurcating the firing assembly whichis described in greater detail below.

A staple 114 has a backspan 115 and a pair of legs 116 projecting fromthe backspan 115. As discussed in greater detail above, the legs arebuckled during formation of the staples 114. As an example not intendedto be limiting, the staple 114 may include a wire diameter of 9.8 or 9.4mils, and may be construced from a material such as titanium.

The staple housing 112 also includes a plurality of staple drivers 120situated adjacent staples 114. The stapler 10 also includes a pluralityof pushers 118 each having at least three linear camming surfaces 1, 2and 3. The pushers 118 may be reusable and integral with a firing rod 90as would be recognized by one of ordinary skill in the art.Alternatively, the pushers 118 may be replaced with each differentstaple housing 112 in a manner discussed below with reference to FIGS.37-38.

Reference is now made to FIG. 9 with the understanding that, althoughFIG. 9 is a cross-section of the stapler shown in FIGS. 6-12, the crosssection is similar to a cross-section that may be taken on the staplershown in FIGS. 1-5. The staple housing 112 has a plurality oflongitudinally extending pusher slots 121 adapted to receive the pushers118 to afford movement of the pushers in a firing direction (thedirection of the arrow 119 in FIGS. 13-15) between pre-fired (FIG. 21)and fired (FIG. 27) positions. The staple housing 112 has a plurality ofdriver channels 124 for receiving the staple drivers 120 to affordmovement of the staple drivers 120 in a staple driving direction (thedirection of the arrow 126 in FIGS. 13-15) between pre-eject (FIG. 13)and ejected (FIG. 15) positions.

Each of the staple drivers 120 have a cam follower surface 122 forengaging the linear camming surfaces 1, 2 and 3 of pusher 118 to movethe staple driver 120 from the pre-eject toward the ejected position tosubstantially sequentially eject the staples 114 from the staple housing112 and press the ejected staples 114 against the specially shapedsurfaces 7 of the anvil to engage, form and close staples 114 in tissue8 (FIGS. 13-15) clamped between the staple housing 112 and the anvil.

The first camming surface 1 forms a first included angle θ₁ with thestaple driving direction 126. The second camming surface 2 forms asecond included angle θ₂ with the staple driving direction 126 that isgreater than the first included angle θ₁. The third camming surface 3forms a third included angle θ₃ with the staple driving direction 126that is different than the first and second included angles θ₁ and θ₂.The included angles (theta 1, 2 and 3; θ₁, θ₂ and θ₃) that the linearcamming surfaces 1, 2 and 3 form with the staple driving direction 126operate to reduce the amount of longitudinal projection of the staplehousing 112 beyond the distalmost staple 114 in a row and to reduce thefiring force encountered by a surgeon. The angles (theta 1, 2 and 3; θ₁,θ₂ and θ₃) also operate to reduce the amount that the stapler projectsbeyond the distal end 19 of the housing 17.

FIGS. 13 through 15 sequentially illustrate the forming and closing ofstaple 114 in tissue 8. With reference to FIG. 13, the positions of thepusher 118, staple driver 120 and staple 114 are shown when the staple114 is initially piercing tissue 8. At this point, movement of thepusher 118 in the firing direction 119 is translated into movement ofthe staple driver 120 in the staple driving direction 126 by engagementbetween the first camming surface 1 and the cam follower surface 122.The force required to pierce the tissue 8 is small relative to theforces encountered later in the staple forming operation. Thus, theangle θ₁ may be relatively small in order to reduce the overall lengthof the pusher 118 and staple housing 112.

Preferably, the first included angle θ₁, is between about forty-five(45) degrees and about sixty (60) degrees. More preferably, the firstincluded angle is about sixty (60) degrees to reduce the overall lengthof the staple housing 112.

FIG. 14 illustrates the positions of a pusher 118, staple driver 120 andstaple 114 just as the legs 116 of the staple 114 engage the speciallyshaped surfaces 7 of the anvil and begin to buckle. At this point,movement of the pusher 118 in the firing direction 119 is beingtranslated into movement of the staple driver 120 in the staple drivingdirection 126 by the interaction of the second camming surface 2 and thecam follower surface 122. As discussed above, an initial maximumformation force is encountered at approximately this point. As a result,the angle θ₂ is greater than the angle θ₁ to reduce the overallresultant firing force experienced by the surgeon. The angle θ₂ ispreferably between about seventy-three (73) degrees and aboutseventy-eight (78) degrees. It should be noted that a linear cammingsurface in this range provides a predictable engagement angle with thestaple driver 120 during the time when the initial maximum formationforce for a staple is encountered, as opposed to a curvilinear pusherwhere the effective engagement angle between the pusher and stapledriver direction is constantly changing. More preferably θ₂ is aboutseventy-five (75) degrees.

FIG. 15 illustrates the positions of the pusher 118, staple driver 120and staple 114 as the distal ends of the legs 116 of the staple 114 aredeformed along specially shaped surfaces 7 of the anvil and form loops.Generally, just after the legs 116 initially buckle, the formation forcefor an individual staple is reduced, but it is nevertheless greater thanthe force required to pierce tissue 8. A second maximum formation forceis thereafter encountered as discussed in the background section of thisdocument.

When the second maximum formation force of the staple 114 isencountered, movement of the pusher 118 in the firing direction 119 istranslated into movement of the staple driver 120 in the staple drivingdirection 126 by the interaction of the third camming surface 3 and thecam follower surface 122. The angle θ₃ is greater than the angle θ₁ toreduce the overall firing force experienced by the surgeon, but istypically less than the angle θ₂ so that the overall length of thestaple housing 112 and pusher 118 may be reduced. The angle θ₃ ispreferably between about sixty-seven (67) degrees and about seventy-two(72) degrees. In a preferred embodiment, the angle θ₃ is aboutsixty-nine (69) degrees.

From the above it can be seen that each linear surface 1, 2, 3 of thepusher 118 addresses a discrete portion of the staple formation curve(see FIG. 42). For example, the initial linear surface 1 corresponds tothe initial tissue penetration of the staple, the linear surface 2corresponds to the buckling of the staple legs and the third linearsurface 3 corresponds to the terminal portion of the staple formationoperation.

As discussed above, a third maximum formation force may be encounteredsubsequent to the positions of the elements shown in FIG. 15.Optionally, the pusher 118 may include a fourth linear camming surface(not shown) forming an angle θ₄ (not shown) that is greater than theangle θ₃ to accomodate the third maximum formation force.

The firing assembly also includes a firing handle 94 designed to reducethe firing force encountered by the surgeon. Reference is now made toFIGS. 19 and 20 which schematically illustrates the location of thefiring handle 94 on the stapler 10.

The proximal portion of the stapler 10 has first 95 and second 97 sides,top 96 and bottom 98 portions and proximal 101 and distal 103 ends. Afiring handle channel 104 extends between the sides 95 and 97 and ends101 and 103 to define a space between the top and bottom portions 96 and98. At the distal end 103, the proximal portion of the stapler 10 hasfinger engagement surfaces 91 that are sized and shaped to beconveniently engaged by the fingers of a stapler firing hand of asurgeon.

The firing handle 94 is mounted in the firing handle channel 104 formovement in a firing direction between pre-fired (FIGS. 1, 2 and 3 andFIG. 19, dashed lines) and fired positions (FIG. 19, solid lines). Thefiring handle channel 104 is sized and shaped to afford passage of atleast one digit of the surgeons's hand (such as the surgeon's thumb)from one of the sides 95 and 97 to the other of sides 95 and 97. Thefiring handle 94 has thumb engagement surfaces 99 dimensioned and shapedto receive the thumb of the firing hand of a surgeon so that the stapler10 may be fired in a motion that is similar to the motion that may beused to eject fluid from a common syringe. The thumb engagement surfaces99 are preferably designed so that the stapler 10 may be fired by eitherhand of a surgeon, thereby giving the firing assembly of the stapler 10an ambidexterity.

The firing handle 94 is fixedly connected to a firing rod 90 that issituated between the firing handle 94 and the pushers 118. FIGS. 37 and38 illustrate an optional one-way adapter 87 (described in greaterdetail below) that transmits the firing force from the firing rod 90 tothe pushers 118. The optional one-way adapter affords placement of thepushers 118 in the staple housing 112 so that they may be replaced withdifferent staple housings when the stapler is a reloadable disposable ora reusable stapler. The firing rod 90 transmits a firing force from thefiring handle 94 to the pushers 118 to move the pushers 118 in thefiring direction.

A proximal portion of the firing rod is illustrated in FIGS. 1-3 and19-20 by reference character 90'. As best seen in FIG. 1, when thefiring handle 94 is in the pre-fired position, at least a portion of theproximal portion of the firing rod 90' is located within the firinghandle channel 104 and between the proximal and distal ends 101 and 103of the proximal portion of the stapler. The proximal portion of thefiring rod 90' defines a proximal portion firing axis 34 illustrated inFIGS. 19 and 20. The proximal portion firing axis 34 is substantiallyparallel to the firing direction 119. It may be seen in FIGS. 1-3 thatthe proximal portion of the firing rod 90' is rotationally connected tothe rest of the firing rod 90 so that when the proximal portion of thestapler 10 is rotated relative to the housing 17, the proximal portionof the firing rod 90' may rotate relative to the rest of the firing rod90.

As best seen in FIGS. 19 and 20, the firing handle 94 and proximalportion of the firing rod 90' are constructed and arranged to affordtransmission of a force F_(F) directly along the proximal portion firingaxis 34. Since there is substantially no space between the point ofapplication of the force F_(F) (the position where the surgeon placeshis or her thumb) and the proximal portion firing axis 34, the proximalportion of the firing rod 90' remains substantially free of a momentcaused by the surgeon pressing on the firing handle 94 to move thefiring handle from the pre-fired (FIG. 19 dashed lines) to the firedposition (FIG. 19 solid lines). This arrangement of structure reducesthe frictional resistance of the firing assembly by a substantial amountand thus reduces the resultant force experienced by a surgeon.

The stapler 10 also includes a means for preventing the firing handle 94from moving from the pre-fired position toward the fired position untilthe cartridge and anvil retention portions 14 and 16 are moved from theopen toward the closed position. As best seen in FIGS. 1-3, the proximalportion of the stapler 10 includes a rocker arm pivotally mounted by pin61 for movement between a) a blocking position (FIGS. 1 and 2) whichrestricts movement of the firing handle 94 from the pre-fired toward thefired position, and b) a free-movement position (FIG. 3) which affordsmovement of the firing handle 94 from the pre-fired toward the firedposition. A leaf spring 63 biases the rocker arm toward the blockingposition.

The firing handle 94 has notch surfaces 67 for receiving blockingsurface 68 of the rocker arm when the rocker arm is in the blockingposition. The rocker arm also includes lever lock abutment surface 65for engaging surfaces on the locking lever 28 when the lever lock is inthe closed position (FIG. 3). When the locking lever 28 moves from thepartially closed position (FIG. 2) to the closed position (FIG. 3),surfaces on the locking lever 28 engage the lever lock abutment surface65 on the rocker arm and cause the rocker arm to rotate counterclockwisein FIGS. 2 and 3 against the bias of spring 63 from the blocking to thefree-movement position. The rocker arm restricts movement of the firinghandle 94 from the pre-fired toward the fired position unless thecartridge retention and anvil retention portions are in the closedposition.

Optionally, the stapler 10 may include the firing assembly depicted inFIGS. 21-27. The staple housing 112 depicted in FIGS. 21-27 is elongateto define a longitudinal axis substantially parallel to the axis L (FIG.3A). The staple housing 112 has tissue engagement surface 75, andproximal 76 and distal 77 end portions. The staple housing 112 also hasa plurality of longitudinally extending pusher slots 121 adapted toreceive pushers 118 to afford movement of the pushers 118 in a firingdirection between pre-fired (FIGS. 21 and 22) and fired (FIG. 27)positions, and a plurality of driver channels 124 for receiving thestaple drivers 120 to afford movement of the staple drivers 120 in thestaple driving direction 126 between pre-eject and ejected positions.

The firing rod 90 and firing handle 94 are operatively associated withthe pushers 118 for movement between the pre-fired and fired positions.The stapler 10 optionally has a trapping means for trapping either theknife 110 or both the knife 110 and pushers 118 in the distal portion 77(e.g. substantially adjacent the distal end of the staple housing 112)of the staple housing 112 in the fired position. The trapping means alsoprevents return movement of either the knife 110 or preferably both theknife 110 and pushers 118 from the fired (FIG. 27) toward the pre-fired(FIGS. 21 and 22) position once they have been moved from the pre-firedto the fired position. The trapping means physically blocks movement ofeither the knife 110 or both the knife 110 and pushers 118 from thefired toward the pre-fired position.

Generally the elongate staple housing 112 defines a vertical direction(the direction of the arrow 76 in FIG. 22). In FIGS. 22-27, the verticaldirection is substantially perpendicular to the longitudinal axis of thestaple housing 112.

In the preferred embodiment, the trapping means comprises at least oneof the pushers 118 (and preferably all four pushers) having aninterference member, preferably a hook surface 79, and the staplehousing 112 having a trap surface 78 in substantially the distal endportion 77 of the staple housing 112 for receiving the hook surface 79of the pusher 118 when the pusher 118 is in the fired position. Thetrapping means also preferably includes a biasing means, such as aninterference fit between the pushers 118 and the bottom portion of thestaple housing 112 forming the slot 121, for biasing the pushers 118vertically away (downward in FIG. 22) from the tissue to be stapled andfor biasing the hook surface 79 of the pusher 118 into engagement withthe trap surface 78 of the staple housing 112. Alternatively, thebiasing means may comprise engagement between the camming surface of thepusher 118 and ramped surface 69 of the staple housing 112 which movesthe pusher 118 away from the stapled tissue (see FIGS. 26 and 27) sothat the hook surface 79 may engage the trap surface 78.

The stapler 10 may optionally include the knife 110 that is mounted forlongitudinal movement between pre-fired (FIG. 22) and fired (FIG. 27)positions. The knife 110 is also mounted for vertical movement betweena) an extended position (FIG. 22) with the knife 110 projectingvertically beyond the tissue engagement surface 75 of the staple housing112 so that it may cut tissue between applied rows of staples, and b) aretracted position (FIGS. 26 and 27) with the knife 110 less exposedthan in the extended position. Preferably, in the retracted position, atleast a substantial portion of the knife 110 is retracted within thestaple housing 112 to reduce the risk of exposure of medical personnelwho handle the spent housing 112.

To accomplish the longitudinal and vertical movement of the knife 110,the knife 110 may include a generally cylindrical bearing surface 48.The knife is sized and shaped to ride in a guide channel of the staplehousing 112. The guide channel has a cutting motion portion 47 forreceiving the bearing surface 48 as the knife 110 moves between thepre-fired and fired positions. The guide channel also has an abutmentportion 49 situated approximately perpendicular to the cutting motionportion 47 of the guide channel.

When the pushers 118 and knife 110 are in the fired position, thepushers 118 are prevented from moving proximally due to engagementbetween the hook surface 79 and trap surface 78. In event that the hooksurface 79 is inadvertently released from trap surface 78, engagementbetween abutment portion 49 and the bearing surface 48 of the knife 110would restrict longitudinal (proximal) movement of the knife 110 fromthe fired toward the pre-fired position. If the knife 110 and pushers118 are connected to each other as they typically are, the engagementbetween abutment portion 49 and the bearing surface 48 of the knife 110also beneficially prevents return movement of the pushers 118.Preferably, the knife 110 is vertically biased downwardly from theextended toward the retracted position by a biasing means such as aninterference fit with surface 47 created during assembly. Once surface47 is passed, the knife 110 is moved downwardly in the Figures to theretracted position by the biasing means.

While the firing rod 90, pushers 118 and knife may comprise a unitarymonolithic element, the firing rod 90, pushers 118 and knife mayoptionally be associated by means of a one-way coupling 87. The one-waycoupling 87 affords reciprocal movement of the firing rod 90 (and firinghandle 94) between pre-fired and fired positions. When the staplerincludes the trapping means discussed above, the pusher 118 and knife110 are only movable from the pre-fired to the fired position as thetrapping means traps them in the fired position.

FIGS. 37 and 38 illustrate one example of the one way coupling 87.During the movement of the firing rod 90 from the pre-fired toward thefired position, the one-way adapter 87 abuts the knife 110 and pusher118 assemblies and transmits the firing force to those elements. Oncethe pushers 118 and knife 110 reach their distalmost position, thepushers 118 and knife 110 are trapped in that position by the trappingmeans. Because the pushers 118 and knife 110 are trapped, the adapter 87affords separation of the firing rod 90 from the pushers 118 and theknife 110 when the firing handle 94 is moved from the fired toward thepre-fired position.

This one-way coupling 87 affords repeated movement of the firing handle94 between the pre-fired and fired positions. However, the difference inresistance to the movement of the firing handle 94 operates as a tactilefeedback to the user signalling that the pushers 118 and/or knife 110have moved to the fired position, and that the staple housing 112 isempty and should be replaced.

The staple housing 112 may optionally include lockout device 50. Thestructure and function of a lockout device 50 is described in U.S. Pat.application Ser. No. 08/055,817, entitled, "Laparoscopic SurgicalInstrument With a Mechanism For Preventing its Entry Into the AbdominalCavity Once It Is Depleted and Removed From the Abdominal Cavity" filedApr. 30, 1993 and naming Claude A. Vidal, Russell J. Redmond and Alan K.Plyley as inventors, the entire contents of which are herein expresslyincorporated by reference.

FIGS. 28 through 33 illustrate portions of another embodiment ofsurgical stapler generally designated by reference character 10A whichhas many parts that are essentially the same as the parts of the stapler10 shown in FIGS. 21-27 and which have been identified by the samereference numeral to which the suffix "A" has been added.

Like the stapler shown in FIGS. 21-27, the stapler 10A has a staplehousing 112A with tissue engagement surface 75A, proximal 76A and distal77A end portions and trap surface 78A. The stapler 10A also has aplurality of pushers 118A with hook surfaces 79A. The operation of thepushers 118A is similar to the operation of the pushers 118 describedabove.

Like the knife 110, the knife 110A includes a knife bearing surface 48A.Like the staple housing 112, the staple housing 112A has a guide channelwith a cutting motion portion 47A and abutment portion 49A with similaroperations. Unlike the stapler 10, in the stapler 10A, the knife 110A isinitially in a retracted position (FIG. 28) which eliminates the needfor a protective cover and reduces the exposure of the knife 110A. Whenthe knife 110A is moved from the pre-fired toward the fired position,engagement between the journal surfaces 49A of the knife 110A and acamming surface 45 on the staple housing 112A cam the knife 110A fromthe retracted toward the projecting position.

Referring now to FIG. 21, the pushers 118 of the stapler 10 arepreferably substantially aligned longitudinally to reduce the overalllength of the staple housing 112 past the distalmost staple in a row.This arrangement also reduces the longitudinal projection of the stapler10 past the distal end 19 of the housing 19. Also preferably, thestapler 10 includes four pushers which may be utilized to apply eitherfour or six parallel rows of staples. When the stapler 10 includes sixparallel rows of staples, an additional pair of pushers 118 may be addedto the stapler or, alternatively, two of the pushers 118 may be requiredto fire two adjacent rows of staples. As is well known in the art, thismay be accomplished by using a plurality of staple drivers each of whichare adapted to engage two, adjacent staples in adjacent rows of staples.

One example of a staple pattern 125 that may be applied by the stapler10 is illustrated in FIG. 16. Staple pattern 125 is substantiallysymmetrical about the path 85 of the knife 110. If a knife 110 is notpresent in the stapler 10, reference character 85 refers to thecenterline of the six parallel rows of staples.

When the staple pushers 118 are substantially parallel or alignedrelative to the longitudinal axis of the stapler (as shown in FIG. 21),a first, preferred embodiment of staple pattern 130 for use in thestapler 10 is shown in FIG. 17. The staple pattern 130 shown in FIG. 17has a proximal end 131 and a distal end 133. Any line drawn transverseto the longitudinal axis of the staple pattern between the ends 131 and133 will cross at least three staples. In contrast, lines 129 of pattern125 only intersect two staples.

When the staple pushers 118 are substantially parallel or alignedrelative to the longitudinal axis of the stapler, the staple pattern 130is preferred to the staple pattern 125 as, with the staple pattern 130,the pushers 118 are not required to simultaneously overcome the initialmaximum formation force of more than three staples. In contrast, withthe staple pattern 125, the initial maximum formation force of firsttwo, then four, then two etc . . . staples are encountered by thepushers. This is believed to increase the resultant maximum forceencountered by a surgeon. It is also believed to contrubute to aninconsistent firing force experienced by the surgeon as the surgeonfires the staple line.

A second, preferred embodiment of staple pattern for the stapler 10 isshown in FIG. 34 and generally designated 140. That staple pattern has aproximal end 141 and a distal end 142, and six adjacent rows numbered151-156. The staple to staple spacing within each row is substantiallyidentical and is defined as the pitch. Each of the rows 151-156 islongitudinally offset from an adjacent row by a fraction of the pitch.For example, row one 151 may be offset from row two 152 by 1/2 of thepitch. The third row 153 is preferably offset one half of the offsetdistance of rows one 151 and two 152 (e.g. 1/4 of the pitch). The stapleline 140 is symetrical about the centerline or knife travel line 85.

The centerline 85 separates the staple rows 151-156 into a first set151-153 and a second set 154-156. Each of the rows in the first set151-153 are offset from the other two rows in the first set.Additionally, each of the rows in the second set 154-156 are offset fromthe other two rows in the second set. However, note that row 151 is notlongitudinally offset from row 154. Instead, rows 151 and 154 arelongitudinally aligned. Preferably, the first set of rows 151-153 is amirror image of the second set of rows 154-156 about the centerline 85.

A third preferred embodiment of staple pattern for the stapler 10 isshown in FIG. 35 and generally designated 140A. That staple pattern hasa proximal end 141A and a distal end 142A, and six adjacent rowsnumbered 151A-156A. Each of the rows 151A-156A is longitudinally offsetfrom all of the other rows in the pattern including adjacent rows.

The staple to staple spacing within each row 151A-156A is identical andis illustrated as P, the staple row pitch. On each half of the cartridgecenterline 85A the two pairs of three rows (151A-153A and 154A-156A) arelongitudinally offset relative to an adjacent row by 1/3 of the pitch(1/3×P). Rows 153A and 154A are offset by 1/2 of this amount, or 1/6 ofthe pitch (1/6×P).

When the staple pushers 118 are substantially parallel or alignedrelative to the longitudinal axis of the stapler, the staple pattern140A is preferred from a firing force standpoint to the staple pattern125 because the pushers 118 do not encounter more than one initialmaximum formation force at the same time. By separating the occurrencesof the maximum formation forces, the overall force encountered by thesurgeon is reduced and the forces are smoother (more uniform andconstant) than the pattern 125.

The preferred staple row pitch is about 0.156 inches. The longitudinaloffset between rows 151A and 152A is preferably about 0.052 inches.Between rows 152A and 153A the preferred offset is about 0.052 inches.The longitudinal offset between rows 153A and 154A is about 0.026 inchesand the offset between rows 154A and 155A as well as between rows 155Aand 156A is preferably about 0.052 inches. The distance betweenbackspans in adjacent rows is preferably about 0.040 inches. Thedistance between rows 153A and 154A is preferably about 0.080 inches toprovide room for movement of the knife along axis 85A.

A fourth preferred embodiment of staple rows according to the presentinvention is shown in FIG. 36. Like the pattern 140A, in the patternshown in FIG. 36, the staple to staple spacing within each row 151B-156Bis identical and is defined as P, the staple row pitch. The pattern hasa pair of ends including proximal end 141B and distal end 142B. Alsolike the pattern 140A, in the pattern shown in FIG. 36, each of the rows151B-156B are offset relative to all of the other rows in the pattern.

Assuming that pitch remains constant, FIGS. 35 and 36 illustrate two ofseveral combinations of stagger patterns according to the presentinvention. Generally speaking, the force considerations between the rowsshown in FIGS. 35 and 36 are similar, but one stagger pattern may havedesirable clinical advantages over another.

FIGS. 43-48 and 50-52 illustrate optional embodiments of staples for usewith the staplers of the present invention which are believed torestrict the amount of the third maximum formation force mentioned inthe Background section of this document. FIG. 43 illustrates a firstoptional embodiment of staple 300 for use with the staplers according tothe present invention which is believed to be particularly useful forstapling thin tissue. The staple 300 has a backspan 301, and legs 302with tips 303. Unlike prior art tips which are created by a blankingoperation that occurs at an angle perpendicular to the plane of thestaple, the tips 303 are formed from a blanking process which issignificantly less than perpendicular to the plane of the staple. Thetips 303 present an edge contact to the anvil dimple and moreimportantly to the backspan when it is crimped over thin tissue. Thisedge contact affords easy slide off of the staple top face from thebackspan 301 which reduces the third maximum formation force.

FIGS. 43A-43C illustrate optional cross-sections which may be coinedinto the backspan 301. FIG. 43A illustrates an oval cross-section 305,FIG. 43B a triangular or offset ramp cross-section 306, and FIG. 3illustrates an arcuate cross-section 307 with a cam angle surface. Theseenhancements are believed to cause the deflecting tip 303 to move awayfrom the backspan 301 at a much lower force than the prior art flattenedbackspan.

FIGS. 45 and 46 illustrate a second embodiment of optional staple 310for use with a stapler according to the present invention. The staple310 includes a backspan 311 with a groove 316, and legs 312 with tips313. The groove 316 which is shown in only one of many potential shapes(i.e. square, triangular, bowed, etc.) provides additional travel forthe staple tips 313 in order to prevent contact with the backspan 311even in thin tissue. This groove 316 would also serve to stabilize thestaple 310 as it nests in a molded slot in the driver.

FIGS. 47 and 48 illustrate a third embodiment of optional staple 320 foruse with the stapler according to the present invention. The staple 320includes a backspan 321, legs 323 and tips 324. FIG. 49 illustrates ananvil dimple 322 that is fabricated at a slightly offset angle to thestaple line axis. This combination always forces the staple tips to thesame side of the backspan and helps to reduce the third maximumformation force. Notably, if the sides of the anvil dimple shown in FIG.49 are substantially parallel but offset from the firing direction, thenthe anvil dimple may assist in forming the staple shown in FIG. 44.

FIGS. 50-52 illustrate a fourth embodiment of optional staple 330 foruse with the staplers according to the present invention. The stapleincludes a backspan 331 with a lateral displacement 332, and legs 333with tips 334. This feature allows the tips 334 of the staple 330 toavoid contact with the backspan 331 when used with a prior art dimple.Although the amount of offset may be practically limited by the width ofthe staple housing staple slot, there may be sufficient room to displacethe backspan at least one-half of the staple wire diameter.

Optionally, the stapler 10 may include a flushing channel 9 having aflush port 3 (FIG. 1). If the stapler 10 comprises a reusable staplerdesigned to be sterilized, the flushing port 3 may assist in cleaningand sterilizing the internal elements of the stapler 10.

FIGS. 6 through 12 and 41 illustrate portions of another embodiment ofsurgical stapler generally designated by reference character 200 whichhas many parts that are essentially the same as the parts of the stapler10 shown in FIGS. 1-5 which have been identified by the same referencenumeral to which the suffix "B" has been added.

The proximal portion of the stapler 200 is substantially identical tothe proximal portion of the stapler 10 except that the stapler 200 doesnot have a torsion spring 31. Like the stapler 10, the stapler 200 hascartridge and anvil retention portions 14B and 16B. A significantdifference between the staplers 10 and 200 is that the stapler 200 has adifferent approximation means than the stapler 10. Like the stapler 10,the approximation means of the stapler 200 comprises three assemblieswhich are best seen in FIGS. 8 and 10-12.

The first assembly comprises a cartridge frame 22B that is fixedlymounted relative to the housing 17B in a manner such that the cartridgeframe 22B does not move relative to the housing 17B. Of course, like thestapler 10, in the stapler 200, the housing 17B may rotate relative tothe proximal portion of the stapler, but the housing 17B does not movelongitudinally or rotate relative to the cartridge frame 22B. Thecartridge frame 22B has opposite first and second side bearing surfaces23B and 25B which are laterally spaced about the longitudinal axis ofthe stapler 200.

The second assembly of the approximation means for the stapler 200comprises a longitudinal movable assembly. The longitudinal movableassembly is operatively associated with locking lever 28B and controlshaft 42B and is movable between an open position (FIGS. 6 and 10) and aclosed position (FIGS. 7 and 11).

A clevis (similar to the clevis 44 shown in FIG. 5A) fixedly attaches apair of transversely spaced guide members 46B to the control shaft 42Bso that the guide members 46B do not move relative to the control shaft42B. The first and second bearing surfaces 23B and 25B of the cartridgeframe 22B receive and abut their respective guide members 46B and assistin constraining the guide members 46B to substantially axiallongitudinal movement relative to the housing 17B and cartridge frame22B.

The guide members 46B each have a first, proximal control groove 201 anda second, distal control groove 203. To close the stapler 200, thecontrol shaft 42B is moved proximally from the position in FIG. 6 to theposition in FIG. 7 substantially linearly and parallel to the axis ofthe stapler 200. Reversing the direction of the control shaft 42B (e.g.distal movement of the shaft 42B) opens the stapler 200.

The third assembly of the approximation means of the stapler 200comprises an anvil assembly which includes the anvil retention portion16B. The anvil assembly includes a proximal portion 204 sandwichedbetween guide members 46B and terminating in a proximal end. The anvilassembly also has a distal end. Proximal post 211 and distal post 212project laterally or transversely from spaced positions on the sides ofthe proximal portion 204 and are fixedly attached to the proximalportion of the anvil 204.

The proximal post 211 is sized and shaped to be received in thesubstantially longitudinally extending slot 201 of the guide member 46B.The proximal post 211 affords pivotal movement of the anvil relative tothe guide member 46B. The distal post 212 is sized and shaped to bereceived in the slot 203. The post 211 is mounted in the anvil andindexed into the cartridge frame 22B. The post 211 restrictslongitudinal movement of the anvil relative to the housing 17B andcartridge frame 22B.

The stapler 200 includes a torsion spring 220 having first 221 andsecond 222 ends. The first end 221 abuts the housing 17B and the secondend abuts the proximal portion 204 of the anvil. The torsion spring 220biases the anvil toward the open position. Latch 33B engages retentionsurfaces on release lever 35B to secure the locking lever 28B in theclosed position against the bias of torsion spring 220. Preferably, inthe embodiment shown, the spring 220 does not communicate with the lever28B.

The torsion spring 220 provides an indexing location for a disposablecartridge pusher assembly. The torsion spring 220 also provides a detentfor the cartridge/staple housing as it is inserted. The spring 20provides a detent to give the user a tactile `click` whencartridge/staple housing has been properly inserted.

The shapes of the first and second control grooves or slots 201 and 203control the motion of the anvil retention portion 16B as it moves froman open to a closed position. Preferred shapes of the slots 201 and 203are illustrated. The groove 201 extends substantially longitudinally andaffords pivotal movement of the anvil relative to the guide member 46Babout post 211.

The groove 203 includes closing cam portion 217 which cams the post 212(and thus the cartridge retention portion 16B) to the closed positionwhen the guide members 46B are moved proximally relative to the anvil.The groove 203 also has positive opening cam portion 227. FIG. 12illustrates the anvil retention portion 16B and the cartridge retentionportion 14B in an emergency open position. If for any reason the anvilretention portion 16B and the cartridge retention portion 14B do notmove from the closed toward the open position under the bias of torsionspring 220, the positive opening cam portion 227 may be used topositively cam the anvil retention portion 16B and the cartridgeretention portion 14B toward the open position. To use the positiveopening cam portion 227, the surgeon merely moves the lever lock 28Bfrom the position in FIG. 7 toward the position in FIG. 6.

While the staplers 10 and 200 comprise staplers for use in alaparoscopic surgical procedures, it should be noted that many of thefeatures and devices disclosed herein may be used in a stapler designedfor use in an open surgical procedure. FIGS. 39 and 40 illustrate astapler 300 for use in an open surgical procedure.

The stapler 300 may be substantially identical to the stapler 10, exceptthat the relatively long housing portion 17 is replaced by a very shortportion and preferably, the stapler 300 would comprise first and secondseparable parts (not shown) which is typical for surgical staplers usedin open surgical procedures. Like the stapler 10, the stapler 300includes cartridge and anvil retention portions 14C and 16C, similarapproximation means, a staple housing 112C, firing handle 94C, firingrod 90C, latch 33C and release lever 35C.

The stapler 300 optionally includes a firing assembly generallyidentical to the firing assembly illustrated in FIGS. 1-3, 13-15 and19-20 and includes a firing handle 94C, firing rod 90C and the pusherassembly generally identical to the pusher assembly shown in FIGS. 13-15which include pushers 118 with linear cam surfaces 1-3. The stapler 300may optionally place staples in any of the patterns illustrated in FIGS.17 and 34-36. Additionally, the stapler 300 may also include thetrapping means illustrated in FIGS. 21-27 and 28-33.

The materials used to construct the staplers according to the presentinvention may comprise any materials suitable for use in surgicaldevices. Such materials are widely known to those skilled in the art.Examples of medical grade materials include particular grades ofstainless steel and plastics.

The present invention has now been described with reference to severalembodiments thereof. It will be apparent to those skilled in the artthat many changes can be made in the embodiment described withoutdeparting from the scope of the present invention. For example, thestaplers 10 and 200 may incorporate the overload sensor and lockoutdevice as disclosed in U.S. patent application Ser. No. 08/237,004,Attorney Docket No. 49657USA6A, and naming Claude A. Vidal, Alan K.Plyley and Roger Lagerquist as inventors. Additionally, either theindividual staples and/or the anvil may be coated to reduce the firingforces encountered by the surgeon. Potential coatings include Teflon,diamond like carbon and tungsten disulfide (Dicronite). Optionally, thestaples may be clad with the same material as the anvil to reduce anypotential cold welding problems. Thus the scope of the present inventionshould not be limited to the structure described in this application,but only by structures described by the language of the claims and theequivalents of those structures.

What is claimed is:
 1. A surgical stapler for applying staples to compressed tissue comprising:a handle portion having surfaces adapted to be manually grasped by a surgeon; a cartridge retention portion and an anvil retention portion, means for mounting said cartridge retention portion and said anvil retention portion for relative movement between a closed position in which said cartridge retention portion and said anvil retention portion are in closely spaced relationship for clamping tissue to be stapled therebetween and an open position in which said cartridge retention portion and said anvil retention portion are spaced farther from each other than in the closed position, an anvil having a plurality of specially shaped surfaces, said cartridge retention portion having a staple housing for enclosing six rows of staples in substantially parallel, linear rows having proximal and distal ends, said six rows being spaced laterally across the staple housing such that any line drawn laterally across the staple line crosses at least three staples, staple drivers adjacent staples, and a plurality of pushers each having camming surfaces, said staple housing being elongate to define a longitudinal axis, said staple housing having a plurality of longitudinally extending pusher slots adapted to receive said pushers to afford movement of said pushers in a firing direction between pre-fired and fired positions, and a plurality of driver channels for receiving said staple drivers to afford movement of said staple drivers in a staple driving direction between pre-eject and ejected positions; and each of said staple drivers having a cam follower surface for engaging the camming surface of a pusher to move the staple driver from the pre-eject toward the ejected position to substantially sequentially eject the staples in a row from the staple housing and press the ejected staples against the specially shaped surfaces of the anvil to engage, form and close staples in tissue clamped between the staple housing and the anvil.
 2. A surgical stapler for applying staples to compressed tissue comprising:a handle portion having surfaces adapted to be manually grasped by a surgeon; a cartridge retention portion and an anvil retention portion, means for mounting said cartridge retention portion and said anvil retention portion for relative movement between a closed position in which said cartridge retention portion and said anvil retention portion are in closely spaced relationship for clamping tissue to be stapled therebetween and an open position in which said cartridge retention portion and said anvil retention portion are spaced farther from each other than in the closed position, an anvil having a plurality of specially shaped surfaces, said cartridge retention portion having a staple housing for enclosing six adjacent rows of staples in substantially parallel, linear rows, the distance between adjacent staples in the same row defining a staple pitch P, said six rows being spaced such that each row is longitudinally offset from all of the other rows, staple drivers adjacent staples, and a plurality of pushers each having camming surfaces, said staple housing being elongate to define a longitudinal axis, said staple housing having a plurality of longitudinally extending pusher slots adapted to receive said pushers to afford movement of said pushers in a firing direction between pre-fired and fired positions, and a plurality of driver channels for receiving said staple drivers to afford movement of said staple drivers in a staple driving direction between pre-eject and ejected positions; each of said staple drivers having a cam follower surface for engaging the camming surface of a pusher to move the staple driver from the pre-eject toward the ejected position to substantially sequentially eject the staples in a row from the staple housing and press the ejected staples against the specially shaped surfaces of the anvil to engage, form and close staples in tissue clamped between the staple housing and the anvil.
 3. A surgical stapler according to claim 2 wherein the staples in each of the rows are longitudinally offset at least 1/6 of the pitch P from any staple in any of the other rows.
 4. A surgical stapler according to claim 3 wherein one of the rows is longitudinally offset 1/3 of the pitch from each of the adjacent rows.
 5. A surgical stapler for applying staples to compressed tissue comprising:a handle portion having surfaces adapted to be manually grasped by a surgeon; a cartridge retention portion and an anvil retention portion, means for mounting said cartridge retention portion and said anvil retention portion for relative movement between a closed position in which said cartridge retention portion and said anvil retention portion are in closely spaced relationship for clamping tissue to be stapled therebetween and an open position in which said cartridge retention portion and said anvil retention portion are spaced farther from each other than in the closed position, an anvil having a plurality of specially shaped surfaces, said cartridge retention portion having a staple housing for enclosing six rows of staples in substantially parallel, linear rows, the distance between adjacent staples in the same row defining a staple pitch P, said six rows of staples being separated into a first set of three parallel linear rows and a second set of three parallel linear rows by a centerline, each of the three parallel linear rows of staples in the first set being spaced such that it is longitudinally offset from the other two rows of staples in the first set, each of the three parallel linear rows of staples in the second set being spaced such that it is longitudinally offset from the other two rows of staples in the second set, staple drivers adjacent staples, and a plurality of pushers each having camming surfaces, said staple housing being elongate to define a longitudinal axis, said staple housing having a plurality of longitudinally extending pusher slots adapted to receive said pushers to afford movement of said pushers in a firing direction between pre-fired and fired positions, and a plurality of driver channels for receiving said staple drivers to afford movement of said staple drivers in a staple driving direction between pre-eject and ejected positions; and each of said staple drivers having a cam follower surface for engaging the camming surface of a pusher to move the staple driver from the pre-eject toward the ejected position to substantially sequentially eject the staples in a row from the staple housing and press the ejected staples against the specially shaped surfaces of the anvil to engage, form and close staples in tissue clamped between the staple housing and the anvil.
 6. A surgical stapler according to claim 5 wherein at least one of said rows of staples in said first set is longitudinally aligned with one of said rows of staples in said second set.
 7. A surgical stapler according to claim 5 wherein said first set of rows is a mirror image of said second set of rows. 